Meeting Access Standards: Behavioral Health Providers’ Role in Supporting UHC Members in NJ
06/09/2025
Timely Access to Care: New Jersey Providers’ Role in Supporting UnitedHealthcare Community Plan Members
In New Jersey, Optum network providers for UnitedHealthcare Community Plan members are vital in ensuring timely access to mental health and substance use disorder services. Adhering to specific appointment access standards is crucial for promoting positive health outcomes and supporting member well-being. This article outlines these standards and their significance.
Why Timely Access Matters
Prompt access to care is essential, particularly for behavioral health. Delays can worsen conditions, increase hospitalizations, and reduce quality of life, especially for Medicaid members facing barriers like socioeconomic challenges or stigma. By meeting contractual access standards, providers help deliver care when it’s needed most, improving recovery and reducing crises.
Appointment Access Standards
Optum network providers in New Jersey must meet the following contractual requirements:
1. Routine Outpatient Care
- Respond to member requests within 24 hours.
- Provide an initial mental health or substance use disorder appointment within 10 business days.
2. Urgent and Emergency Care
- Offer appointments within 24 hours for urgent needs.
- Provide care within 6 hours for non-life-threatening emergencies.
- Ensure immediate access for life-threatening emergencies.
3. Post-Discharge Follow-Up
- Schedule an outpatient appointment within 7 days after an acute inpatient discharge or emergency room visit.
The Provider’s Role
Providers are key partners in delivering high-quality, member-focused care. Meeting these standards ensures members receive timely support, such as therapy for anxiety or follow-up care after inpatient treatment, which can prevent relapses and support long-term recovery.
Challenges and Solutions
Providers may face challenges like high demand or staffing shortages. Solutions include using telehealth, streamlining scheduling, and collaborating with Optum for resources and support to meet these standards effectively.
Source: Optum